MENTOR FATHER APPLICATION CHECKLIST (ALL INFORMATION IS CONFIDENTIAL)
CHECKLIST: PART 1
MENTOR FATHER INFORMATION
PART 2
MENTOR FATHER STATEMENT OF FAITH
PART 3
COMMUNITY LEADER OR PROFESSIONAL REFERENCE
PART 4
BACKGROUND REFERENCE CHECK APPROVAL
PART 5
PASTORAL/PERSONAL REFERENCE
Applicant must obtain this reference
Applicant must obtain this reference
THERE ARE 13 APPLICATION PAGES, PLEASE SUBMIT ALL 13 PAGES. INCOMPLETE APPLICATIONS WILL BE RETURNED. COMPLETE APPLICATION PACKAGES CAN BE SENT TO
[email protected] OR HARD COPIES DELIVERED TO THE CHURCH OFFICE.
Thank you for listening to the heart of God in defending the cause of the fatherless.
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F I E LD FAITH • FATHERHOOD • FORGIVENESS
PART I – MENTOR FATHER INFORMATION (1 OF 3) (ALL INFORMATION IS CONFIDENTIAL) APPLICANT’S NAME Last
First
Middle
Preferred Name
ADDRESS Number & Street City
COUNTY
State
Zip/Postal
PHONE Home
Cell
Day
Evening
E-MAIL ADDRESS CHURCH Name Flatirons Community Curch Phone Number 303-664-5524
BIRTH DATE
/
Fax Number
303-926-0431
/
EMPLOYER Present Employer
How long there?
EDUCATION High School
Graduate Year
Trade School
Certificate Year
College
Years Attended
Degree
Other
MARITAL STATUS q Married
(How long)
q Divorced
(How long)
q Married with Children q Never Married
Names and Ages of Children (if applicable)
Flatirons Community Church
PART I – MENTOR FATHER INFORMATION (2 OF 3)
2
Name of Mentor Father
1. What has led you to consider volunteering as a Mentor Father?
2. What experience do you have working with children?
3. Briefly describe your Christian testimony. (Use back of page if needed.)
4. Explain your past and/or present use of alcohol or any other drugs.
Flatirons Community Church
PART I – MENTOR FATHER INFORMATION (3 OF 3)
3
Name of Mentor Father
5. Do you have a valid driver’s license? q Yes q No Do you have your own transportation? q Yes q No Please describe your driving record and offenses
Do you have sufficient auto insurance to cover injuries sustained to a passenger? q Yes q No 6. Have you ever been involved in, investigated for, arrested and/or convicted of a crime? q Yes q No When? Explain:
7. List two references: (your pastor and one other community leader) Name
Relationship
Address Work Phone
Home Phone
Name
Relationship
Address Work Phone
Home Phone
Please list interests, hobbies, and activities you enjoy.
This information is true and accurate to the best of my knowledge. Signed
Date
Flatirons Community Church
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F I E LD FAITH • FATHERHOOD • FORGIVENESS
PART 2 – STATEMENT OF FAITH FOR MENTOR FATHER (1 OF 2) F. I. T. F. STATEMENT OF FAITH We at Fathers in the Field believe in the following unchangeable truths: We believe in one God, Creator and Lord of the Universe, the co-eternal Trinity; Father, Son, and Holy Spirit. We believe that Jesus Christ, God’s Son, was conceived by the Holy Spirit, born of the Virgin Mary, lived a sinless life, died a substitutionary atoning death on the cross, rose bodily from the dead and ascended to heaven where, as truly God and truly man, He is the only mediator between God and man. We believe that the Bible is God’s authoritative and inspired Word. It is without error in all its teachings, including creation, history, its own origins, and salvation. Christians must submit to its divine authority, both individually and corporately, in all matters of belief and conduct, which is demonstrated by true righteous living. We believe that all people are lost sinners and cannot see the Kingdom of God except through the new birth. Justification is by grace through faith in Christ alone. We believe in one holy, universal, and apostolic Church. Its calling is to worship God and witness concerning its Head, Jesus Christ, preaching the Gospel among all nations and demonstrating its commitment by compassionate service to the needs of human beings and promoting righteousness and justice. We believe in the necessity of the work of the Holy Spirit for the individual’s new birth and growth to maturity, and for the Church’s constant renewal in truth, wisdom, faith, holiness, love, power, and mission. We believe that Jesus Christ will personally and visibly return in glory to raise the dead and bring salvation and judgment to completion. God will fully manifest His kingdom when He establishes a new heaven and new earth, in which He will be glorified forever and exclude all evil, suffering, and death.
I agree, Signature Printed Name
Date
Flatirons Community Church
5 PART 2 – STATEMENT OF FAITH FOR MENTOR FATHER (2 OF 2) STATEMENT OF FAITH I, as an attendee of Flatirons Community Church, believe in the following core values: Biblical Authority | A Better Way To Do Life | To present God’s Word with grace and truth and we recognize its authority and our ned to adjust to it. I am striving to live my life under the authority of the teachings of Jesus Christ as found in the Bible. As a leader, I will do my best to point others back to the Bible as the ultimate authority for truth. Relational Intimacy | Grace and Truth | No matter what disconnected me from God, Jesus is the only way to reconnect with Him. I have made a personal decision to accept the grace offered me through faith in Jesus Christ and I am trusting Jesus as my Savior and Lord. As a leader, I will extend the same grace and truth to others that God has given me. Spiritual Formation | Me too | Pursuing truth together is the best opportunity for truly living out and applying that truth. I will lead out with a “me too” attitude, rather than out of authority or position, and engage in and encourage others to enter into community that seeks Jesus in all aspects of grief and healing. Excellent environments | Bump into Jesus | We are not in the business of changing people. Rather we embrace our role as creating a space where people can work out their stuff with Jesus. I understand that it is not my job to change, fix or save anyone. As a leader, it is my responsibility to provide and protect an environment that allows others to hear from God and process what God may be teaching them. Relational Evangelism | Come and See | We will intentionally leverage our influence in the world for the purpose of introducing people to the awesome love of Christ. As a leader, the best thing I can do for one of my friends is to simply tell my own story and invite them to take a step closer to Jesus and see, hear and decide for themselves the role Jesus wants to take in their life.
I agree, Signature Printed Name
Date
Flatirons Community Church
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F I E LD FAITH • FATHERHOOD • FORGIVENESS
PART 3 - PROFESSIONAL REFERENCE FORM (1 OF 3) Reference should not be related to the applicant. Reference letters do not replace this form. Section A: TO BE COMPLETED BY THE MENTOR FATHER APPLICANT MENTOR FATHER’S APPLICANT NAME Last Middle
First Preferred Name
ADDRESS Number & Street City
COUNTY
State
Zip/Postal
PHONE Home
Cell
Day
Evening
E-MAIL ADDRESS
CHURCH Name Flatirons Community Curch Phone 303-664-5524
Fax
303-926-0431
I,
, GIVE FATHERS IN THE FIELD
PERMISSION TO CONTACT THIS REFERENCE AND WAIVE MY RIGHT TO REVIEW ANY COMMENTS MADE AS A RESULT OF THIS CONTACT. I agree, Signature Applicant’s Name
Date
Flatirons Community Church
PART 3 - PROFESSIONAL REFERENCE FORM (2 OF 3) Section B: TO BE COMPLETED BY COMMUNITY LEADER
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Name of Mentor Father
REFERENCE’S NAME Last
First
Title
How long have you known the applicant?
What do you believe to be the applicant’s greatest strength?
What do you believe to be the applicant’s greatest weakness?
How would you describe the applicant’s awareness of his calling as a Christian and of his response to that calling? (Check one) q Very Solid/Mature q Strong/Thriving q Average/Growing q Probable/Developing q Possible/Vague Not apparent (On a scale of 1-10 with 10 being the highest) How appropriately does the applicant relate to young boys?
Flatirons Community Church
PART 3 - PROFESSIONAL REFERENCE FORM (3 OF 3)
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Section B: TO BE COMPLETED BY COMMUNITY LEADER Name of Mentor Father
Carefully rate the applicant by checking the appropriate rating for each characteristic. On a scale of 1-5, 5 indicates that the applicant excels in that characteristic, and I indicates that the applicant does not demonstrate that characteristic. It is important that you rate the applicant to the best of your knowledge for each characteristic. COMMUNICATION SKILLS
5
4
3
2
1
INTEGRITY
5
4
3
2 1
LEADERSHIP
5
4
3
2
RESPONSIBILITY
5
4
3
2 1
SELF-DISCIPLINE
5
4
3
2
1
SENSITIVITY TO OTHERS
5
4
3
2
1
1
What is your recommendation in respect to this applicant’s admission? (Check one) q Strongly recommend q Recommend q Recommend with reservations q Do not recommend Please list any circumstances / issues of which the Church should be aware before deciding on the applicant’s suitability for a Mentoring Ministry.
Signed
Date
Print Name:
Flatirons Community Church
CONFIDENTAL
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Fathers in the Field Ministry
BACKGROUND CHECK AUTHORIZATION PART 4 - BACKGROUND CHECK AUTHORIZATION PRINT NAME First
Middle
Last
Former Name(s)
Date Used
ADDRESS CURRENT ADDRESS SINCE: Month
Year
Number & Street City
State
PREVIOUS ADDRESS FROM: Month
COUNTY
Zip/Postal
Year
Number & Street City
State
SOCIAL SECURITY # PHONE
Home
DRIVERS LICENSE Number
COUNTY
Zip/Postal
DOB Cell
Work State
The information contained in this application is correct to the best of my knowledge. I hereby authorize Fathers in the Field and its designated agents and representatives to conduct a comprehensive review of my background causing an investigative report to be generated for volunteer purposes. I understand that the scope of the investigative report may include, but is not limited to the following areas: verification of social security number; civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records. I further authorize any corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information pertaining to me, to Fathers in the Field. I further authorize the complete release of any records or data pertaining to me which the corporation, or public agency may have, to include information or data received from other sources. Fathers in the Field and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicants personal information, including, but not limited to, addresses, social security numbers, and dates of birth. I agree, Signature
Date
Notice to California, Minnesota and Oklahoma Residents: Please check the box below if you wish to receive a copy of a report that is requested. q I wish to receive a copy of any Background Check Report on me that is requested.
Flatirons Community Church
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F I E LD FAITH • FATHERHOOD • FORGIVENESS
PART 5 - PASTORAL / PERSONAL RECOMMENDATION (1 of 3) References should not be related to the applicant. Reference letters do not replace this form. Section A: TO BE COMPLETED BY THE MENTOR FATHER APPLICANT MENTOR FATHER’S APPLICANT’S NAME Last Middle
First Preferred Name
ADDRESS Number & Street City
State
COUNTY
Zip/Postal
PHONE Home
Cell
Day
Evening
Fax
E-MAIL ADDRESS
I,
, GIVE FATHERS IN THE FIELD
PERMISSION TO CONTACT THIS REFERENCE AND WAIVE MY RIGHT TO REVIEW ANY COMMENTS MADE AS A RESULT OF THIS CONTACT. Applicant’s Name I agree, Signature
Date
Flatirons Community Church
PART 5 - PASTORAL / PERSONAL RECOMMENDATION (2 of 3) Section B: TO BE COMPLETED BY PASTOR Flatirons Community Church Pastor, Ministry Leader or other Church Pastor
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Name of Mentor Father
PASTOR’S NAME Last
First
Title
How long have you known the applicant?
How long has he been a member of your Church?
What do you believe to be the applicant’s greatest strength?
What do you believe to be the applicant’s greatest weakness?
How would you describe the applicant’s awareness of his calling as a Christian and of his response to that calling? (Check one) q Very Solid/Mature q Strong/Thriving q Average/Growing q Probable/Developing q Possible/Vague Not apparent (On a scale of 1-10 with 10 being the highest) How appropriately does the applicant relate to young boys? Flatirons Community Church
PART 5 - PASTORAL / PERSONAL RECOMMENDATION (3 of 3)
12
Section B: TO BE COMPLETED BY PASTOR Flatirons Community Church Pastor, Ministry Leader or other Church Pastor Name of Mentor Father
Carefully rate the applicant by checking the appropriate rating for each characteristic. On a scale of 1-5, 5 indicates that the applicant excels in that characteristic, and I indicates that the applicant does not demonstrate that characteristic. It is important that you rate the applicant to the best of your knowledge for each characteristic. COMMUNICATION SKILLS
5
4
3
2 1
INTEGRITY
5
4
3
2 1
LEADERSHIP
5
4
3
2
RESPONSIBILITY
5
4
3
2 1
SELF-DISCIPLINE
5
4
3
2
1
SENSITIVITY TO OTHERS
5
4
3
2
1
1
Please list any circumstances of which Fathers in the Field should be aware before deciding on the applicant’s suitability for the ministry.
Mentor Father Applicant Names, RECOMMENDATION to be a Mentor Father.
Pastor’s Signature
has my
Date
Pastor’s Title Flatirons Community Church
